Two OEF/OIF veterans received VALOR therapy in two separate case studies.49 These veterans greatly reduced their alcohol use at the start of treatment or shortly before beginning the treatment, and their PTSD symptoms substantially decreased over the course of treatment. Eight of the veterans showed clinically reliable reductions in PTSD outcomes after treatment. Most of the veterans showed clinically reliable reductions in their percentage of days of heavy drinking.

It is also plausible that reduction of alcohol use may have partially mediated the reduction of depressive symptoms. The comparative effectiveness between serotonergic and noradrenergic antidepressants in reducing depressive symptoms has been studied in numerous trials in the depression literature (47). In a meta-analysis of 15 head-to-head RCTs comparing SSRIs and SNRIs showed that SNRIs had statistical significance over SSRIs in treating MDD (47); these studies did not include participants with AUD. However, in that study, desipramine was categorized as a tricyclic antidepressant, which did not show any statistically significant difference in both depression and AUD outcomes when compared to SSRIs (including paroxetine) (48). Repeated measures tests indicated that endorsement of alcohol use, cigarette use, and prescription drug misuse was similar during active duty and post-separation, and marijuana and hard drug use endorsement increased significantly in the 6-mo period post-separation. Active duty levels of anxiety/depression and aggressive feelings were maintained from active duty to post-separation, and feeling alone and military-based trauma symptoms increased significantly.

Existing Research on Military Separation

In order to maintain long-term sobriety, veterans are encouraged to continue counseling and partake in support groups like Alcoholics Anonymous and Al-Anon. It’s also beneficial that veterans in recovery have a support system in place to help provide motivation in times of need. All substance use results are reported in Table I. Most participants endorsed alcohol use, with 91.5% reporting active duty use and 88.6% reporting post-separation use. Regarding cigarette use, 40.7% of participants reported active duty use and 37.5% reported post-separation use. Between six and eight of every ten (or 60% to 80% of) Vietnam Veterans seeking PTSD treatment have alcohol use problems.

Selective serotonin reuptake inhibitors (SSRIs), including paroxetine, are first-line evidence-based pharmacotherapies for both PTSD and depression (12, 13). The literature evaluating the effectiveness of SSRIs when used in individuals with comorbid AUD is mixed. Studies mostly support the use of SSRIs in reduction of PTSD and depressive symptoms in patients who have AUD with co-occurring PTSD (14, 15) and MDD (16, 17), respectively. However, most studies do not support the role of SSRIs in improving alcohol use outcomes in patients with co-occurring PTSD and AUD (15, 18–22) and MDD and AUD (20, 23). Due to repercussions of admitting to substance use while in active duty, we chose to employ a single, retrospective data collection after participants had transitioned from the military.

Depression, PTSD, and Anxiety: Mental Health Concerns in the Army

There are symptoms and reactions missing from the DSM that Soldiers often talk about, like extreme anger, grief, second guessing. Castro said the nature of impairment for Soldiers is often quite different than for civilians. „But in the military when you deploy to Iraq or Afghanistan or anywhere, your sleep is probably already disrupted. So you’re probably already not sleeping well prior to ever being exposed to a traumatic event,“ he said. „Our current treatments, both psycho and drug therapies, were developed to treat rape and assault victims and had never been validated for use for combat-related PTSD. Choosing to seek treatment for alcoholism is a life-changing decision and should not be taken lightly. Getting help for a drinking problem is an investment in yourself and a better future.

As shown by Dickstein and colleagues (2010), military members who exhibit a pretrauma history of alcohol misuse may be prone to exhibit poorer recovery from PTSD symptoms following trauma exposure. Therefore, interventions to screen for a history of alcohol misuse also may help to target individuals who are at risk for developing increasingly severe PTSD symptoms following military trauma https://ecosoberhouse.com/article/ptsd-and-alcohol-abuse/ exposure. Not only do alcohol use disorders complicate recovery from posttraumatic mental health disorders, such as PTSD, but these stress-related conditions have been found to impede recovery from alcoholism. Ouimette and colleagues (1999) found that substance-dependent veterans with PTSD had poorer substance abuse treatment outcomes after 2 years compared with those without PTSD.

Prevalence of PTSD and AUD in Military and Veteran Populations

With longer and more frequent deployments, as well as technological advances allowing servicemembers to connect with family while deployed, post 9/11 servicemembers may be particularly impacted by stressors at home while deployed (Cigrang et al., 2014). Further, these disruptions may disproportionately impact women (Malone et al., 1996; cf. King et al., 2006). Taken together, servicemembers who have difficulties coping with ptsd and alcoholism Life Disruptions and deployment traumas, may develop symptomatology in response to these experiences, and may be more likely to drink post-deployment to cope with these stressors. Thus, by solely examining the impact of deployment traumas (i.e., combat, MST) on post-deployment PTSD and alcohol use, we ignore the effects of other critical (and potentially more easily modifiable) life stressors impacting alcohol use.

Recent research suggests that the separation transition from active duty to civilian life may be critical in terms of the future functioning of the veteran. Data were analyzed from 615 veterans from a nationally representative study of U.S. veterans who met criteria for probable full or subthreshold PTSD. Path analyses examined the role of self-sufficient, socially-supported, and avoidant coping strategies in mediating associations between PTSD symptom clusters and alcohol use disorder (AUD), alcohol consumption, and alcohol-related consequences. Self-medication hypotheses suggest some individuals drink to avoid painful emotions (Baker, Piper, McCarthy, Majeskie, & Fiore, 2004).